Journal of the American Medical Association
Table of Contents - June 19, 2002
Vol 287, No. 23 pp 3035 - 3166
http://jama.ama-assn.org/issues/v287n23/toc.html

Books/Mental Illness
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
by Robert Whitaker, 334 pp, $27, ISBN 0-7382-0385-8, Cambridge, Mass, Perseus
Publishing, 2002.
Reviewed by
Daniel J. Luchins, MD

Robert Whitaker, an award-winning journalist, presents a caustic history of American psychiatry's treatment of schizophrenia. Starting with the Colonia era practice of spinning in a gyrator, the litany continues with chilling ice baths, dental extractions, therapeutic sterilization, malarial therapy, insulin coma, electroconvulsive treatment, and frontal lobotomy, and ends with the typical antipsychotics and their new generation cousins. Each treatment, the author points out, was justified by a specific scientific hypothesis consistent with that era's broader theory of mental illness. In Colonial and post-Revolutionary times, insanity was seen as a loss of reason, a return to the bestial that required firmness and, at times, terror. Post-Darwin it was a product of faulty germ plasm, which required confinement and sterilization to protect the gene pool. Today, it is considered a biochemical abnormality that necessitates treatment with pharmaceutical agents, just as diabetes requires insulin. For Whitaker, the only bright spot in 200 years of mistreatment is the short-lived era of Moral Treatment. As he makes clear, it originated in a religious inclination to treat the mentally ill as brethren, which organized medicine subverted and then overthrew.

Full text
http://jama.ama-assn.org/issues/v287n23/ffull/jbk0619-3.html
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
by Robert Whitaker
Hardcover: 304 pages ; Dimensions (in inches): 1.10 x 9.20 x 6.32
Publisher: Perseus Publishing; ISBN: 0738203858; (January 8, 2002)
AMAZON - US
http://www.amazon.com/exec/obidos/ASIN/0738203858/darwinanddarwini/
AMAZON - UK
http://www.amazon.co.uk/exec/obidos/ASIN/0738203858/humannaturecom/

Amazon.com
Hot on the heels of an optimistic film about Nobelist John Nash's schizophrenic journey comes medical journalist Robert Whitaker's disturbing expose of the cruel and corrupt business of treating mental illness in America. Mad in America begins by surveying three centuries of mental health treatments to discover why positive outcomes for schizophrenics in the U.S. for the last 25 years have decreased--making them lower than those in developing countries. Whitaker asks, "Why should living in a country with such rich resources and advanced medical treatments for disorders of every kind, be so toxic to those who are severely mentally ill?"

One of Whitaker's answers draws upon the historic and current assumptions of a physical cause for schizophrenia. This resulted in cruel and unusual physical treatments--from ice-water immersion and bloodletting to the more contemporary electroshock, lobotomy, and drug therapies with dangerous side effects. This physical cause model leads to Whitaker's more provocative explanation: that mental illness has become a profit center. He offers disturbing details about how good business for drug companies makes for bad medicine in treating schizophrenia. From drug companies skewing their studies and patient/subjects kept in the dark about experiments to the cozy relationship between the American Psychiatric Association and drug companies, Whitaker underlines the mistreatment of the mentally ill. This courageous and compelling book succeeds as both a history of our attitudes toward mental illness and a manifesto for changing them.
--Barbara Mackoff

From Publishers Weekly
Tooth removal. Bloodletting. Spinning. Ice-water baths. Electroshock therapy.
These are only a few of the horrifying treatments for mental illness readers encounter in this accessible history of Western attitudes toward insanity. Whitaker, a medical writer and Pulitzer Prize finalist, argues that mental asylums in the U.S. have been run largely as "places of confinement facilities that served to segregate the misfits from society rather than as hospitals that provided medical care." His evidence is at times frightening, especially when he compares U.S. physicians' treatments of the mentally ill to medical experiments and sterilizations in Nazi Germany. Eugenicist attitudes, Whitaker argues, profoundly shaped American medicine in the first half of the 20th century, resulting in forced sterilization and other cruel treatments. Between 1907 and 1927, roughly 8,000 eugenic sterilizations were performed, while 10,000 mentally ill Americans were lobotomized in the years 1950 and 1951 alone. As late as 1933, there were no states in which insane people could legally get married. Though it covers some of the same territory as Sander Gilman's Seeing the Insane and Elaine Showalter's The Female Malady, Whitaker's richer, more detailed book will appeal to those interested in medical history, as well as anyone fascinated by Western culture's obsessive need to define and subdue the mentally ill. Agent, Kevin Lang.
Copyright 2002 Cahners Business Information, Inc.

From Booklist
*Starred Review* American psychiatry has excelled throughout the nation's history, but doctors and drug manufacturers have profited far more than psychiatric patients. When the World Health Organization compared schizophrenics' recovery rates in the U.S and in nations too poor to afford the latest psychopharmaceuticals, it found that a Third World patient was exponentially likelier than an American one to regain sanity. Whitaker's articulate dissection of "mad medicine" in the U.S. explains why that dismaying contrast obtains. Assuming that insanity arises from identifiable physical causes, American psychiatry theorized about those causes and sought to find physical therapies and, later, drugs that attacked those causes. Accordingly, from being shocked with cold water and repeatedly nearly drowned, to suffering chemically and electronically induced grand mal seizures, to having the frontal lobes of their brains chopped off, to being drugged into parkinsonism (thepreferred modus nowadays), the mad in America have suffered as essentially nonconsensual experimental subjects. Since World War II, drug companies havemade continued testing increasingly worthwhile, despite the lack of encouraging results. This horrifying history is all the more discomfiting because another mode of treatment was successfully used from the late eighteenth century until the 1870s. Called moral treatment by its Quaker champions, it involved treating the mad with kindness and sympathetic companionship rather than drugs and machines. But it cost too much, and it wasn't professional. Ray Olson
Copyright © American Library Association. All rights reserveds

From Book News, Inc.
Investigative journalist Whitaker tells the story of the treatment of schizophrenia in the United States from 1900 up until the present day. While many would recognize his tales of forced lobotomies, electroshock therapies, and other past "treatments" to be shameful reminders of an ignorant past, Whitaker saves his greatest outrage for the practices of the present. Noting the disturbing facts that outcomes for schizophrenics are worse today than they were 25 years ago and that outcomes are worse in the industrialized nations than they are in the developing world, he argues that the current regime of anti-psychotics (called "atypicals") is not based on good science and has been pushed by companies more concerned with raking in profits than with concern for patients.Book News, Inc.®, Portland, OR

The Baltimore Sun
"The book's lessons about the medical dangers of greed, ego and sham are universal and couldn't be more timely."

South Florida Sun-Sentinel
"People should read this excellent book and learn which questions to ask before filling that "miracle" prescription."

Mother Jones
"Passionate, compellingly researched polemic, as fascinating as it is ultimately horrifying."

Kirkus
"An absorbing, sometimes harrowing history of the medical treatment in the US..."

Book Description
A riveting social and medical history of madness in America, from the 17th century to today. In Mad in America, medical journalist Robert Whitaker reveals an astounding truth: Schizophrenics in the United States fare worse than those in poor countries, and quite possibly worse than asylum patients did in the early nineteenth century. Indeed, Whitaker argues, modern treatments for the severely mentally ill are just old medicine in new bottles and we as a society are deluded about their efficacy. Tracing over three centuries of "cures" for madness, Whitaker shows how medical therapies-from "spinning" or "chilling" patients in colonial times to more modern methods of electroshock, lobotomy, and drugs-have been used to silence patients and dull their minds, deepening their suffering and impairing their hope of recovery. Based on exhaustive research culled from old patient medical records, historical accounts, and government documents, this haunting book raises important questions about our obligations to the mad, what it means to be "insane," and what we value most about the human mind.

About the Author
Robert Whitaker's articles on the mentally ill and the drug industry have won several awards, including the George Polk Award for medical writing and the National Association of Science Writers' Award for best magazine article. He was named a finalist for the Pulitzer Prize for a Boston Globe series he co-wrote in 1998. Whitaker lives in Cambridge, Massachusetts.

The Human Nature Review 2002 Volume 2: 95-98 ( 11 March )
URL of this document http://human-nature.com/nibbs/02/mia.html

Book Review
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
by Robert Whitaker
Perseus Press, 2002

Reviewed by Claudia Bukszpan Rutherford, Ph.D.Robert Whitaker, whose articles on mental health have won several awards, reports in Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill that over the past 25 years, treatment outcomes for schizophrenics in the United States have worsened. They are "no better now than they were in the first decades of the twentieth century, when the therapy of the day was to wrap the insane in wet sheets," he asserts. Moreover, schizophrenia outcomes in developed countries today are much worse than in the poorer nations of the world.

To understand these apparent failures, Whitaker argues, one must examine the history of the care of schizophrenics in the West, as well as the attitudes behind each era's approach. Chronicling the treatment of schizophrenics from the 1750s till today, Whitaker creates a review that is by turns interesting, informative, and horrifying. Except for "moral treatment" in the 1800s, management of schizophrenics over the last 250 years appears to have been little more than a dressed-up series of one type of shackling after another. First, patients were literally subdued and fettered via the use of physical restraints; nowadays, says Whitaker, they are shackled chemically instead, with neuroleptic drugs that receive far more praise than they deserve.

Although some of the author's points about the flaws of neuroleptics are well-taken (e.g., the high incidence of extrapyramidal side effects and tardive dyskinesia), at times the book is more bombastic diatribe against psychopharmacological treatment of schizophrenia than an effort to suggest realistic alternatives. The book's often outraged tone ironically and unfortunately detracts from some of its quite valid points.

Full text http://human-nature.com/nibbs/02/mia.html